By: West S.B. No. 1339
A BILL TO BE ENTITLED
AN ACT
relating to the authority of advanced practice registered nurses to
make medical diagnoses and to prescribe and order prescription
drugs and devices.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 157.051(1), Occupations Code, is amended
to read as follows:
(1) "Advanced practice nurse" has the meaning assigned
to that term by Section 301.152, except the term does not include an
advanced practice registered nurse granted prescribing and
ordering authority under Section 301.357. The term includes an
advanced nurse practitioner.
SECTION 2. Section 157.052(3), Occupations Code, is amended
to read as follows:
(3) "Registered nurse" means a registered nurse
recognized by the Texas Board of Nursing as having the specialized
education and training required under Section 301.152 to carry out
or sign a prescription drug order under this subchapter.
SECTION 3. Section 301.002(2), Occupations Code, is amended
to read as follows:
(2) "Professional nursing" means the performance of an
act that requires substantial specialized judgment and skill, the
proper performance of which is based on knowledge and application
of the principles of biological, physical, and social science as
acquired by a completed course in an approved school of
professional nursing. The term does not include acts of medical
diagnosis or the prescription of therapeutic or corrective measures
except as authorized for advanced practice registered nurses under
Section 301.357. Professional nursing involves:
(A) the observation, assessment, intervention,
evaluation, rehabilitation, care and counsel, or health teachings
of a person who is ill, injured, infirm, or experiencing a change in
normal health processes;
(B) the maintenance of health or prevention of
illness;
(C) the administration of a medication or
treatment as ordered by a practitioner, as that term is defined by
Section 551.003 [physician, podiatrist, or dentist];
(D) the supervision or teaching of nursing;
(E) the administration, supervision, and
evaluation of nursing practices, policies, and procedures;
(F) the requesting, receiving, signing for, and
distribution of prescription drug samples to patients by an
advanced practice registered nurse with prescriptive authority or
at sites in which a registered nurse is authorized to sign
prescription drug orders as provided by Subchapter B, Chapter 157;
(G) the performance of an act delegated by a
physician under Section 157.052, 157.053, 157.054, 157.0541,
157.0542, 157.058, or 157.059; [and]
(H) the prescribing of controlled substances and
dangerous drugs and medical devices by an advanced practice
registered nurse with provisional or full prescriptive authority;
and
(I) the development of the nursing care plan.
SECTION 4. Section 301.152, Occupations Code, is amended by
amending Subsections (a) and (b) and adding Subsection (c-1) and
(c-2) to read as follows:
(a) In this section, "advanced practice nurse" means a
registered nurse approved by the board to practice as an advanced
practice nurse on the basis of completion of an advanced
educational program. The term includes a nurse practitioner, nurse
midwife, nurse anesthetist, and clinical nurse specialist. The
term is synonymous with "advanced nurse practitioner" and "advanced
practice registered nurse."
(b) The board shall adopt rules to:
(1) establish:
(A) any specialized education or training,
including pharmacology, that a registered nurse must have to:
(i) prescribe and order drugs and medical
devices under Chapter 157; or[carry out a prescription drug order
under Section 157.052; and]
(ii) prescribe and order drugs and medical
devices under Section 301.357; and
(B) a system for assigning an identification
number to a registered nurse who provides the board with evidence of
completing the specialized education and training requirement
under Paragraph (A)(i) or (ii) [Subdivision (1)(A)];
(2) approve a registered nurse as an advanced practice
nurse; and
(3) initially approve and biennially renew
provisional prescriptive authority to an advanced practice nurse
['s authority] to:[carry out or sign a prescription drug order
under Chapter 157.]
(A) prescribe and order drugs and medical devices
under Chapter 157; or
(B) prescribe and order drugs and medical devices
during a post-graduate preceptorship supervised by an advanced
practice nurse with full prescriptive authority under Section
301.357.
(4) finally approve and biennially renew full
prescriptive authority to an advanced practice nurse to prescribe
and order drugs and medical devices under Section 301.357.
(c-1) At a minimum, the rules adopted under Subsection
(b)(4) must allow for approval of an advanced practice nurse who has
practiced for a minimum of 500 hours with the authority to prescribe
and order drugs and medical devices granted by the Board of Nursing
in another state and is otherwise qualified.
(c-2) For final approval under Subsection (b)(4), the rules
must require the completion of 500 hours of practice as an advanced
practice nurse with prescribing and ordering authority under:
(1) Subsection (b)(3)(A);
(2) Subsection (b)(3)(B);
(3) Subsection (c-1); or
(4) a combination of hours gained under (b)(3)(A),
(b)(3)(B), or (c-1).
SECTION 5. Subchapter H, Chapter 301, Occupations Code, is
amended by adding Section 301.357 to read as follows:
Sec. 301.357. PRESCRIBING AND ORDERING AUTHORITY OF CERTAIN
NURSES. (a) The board may grant provisional prescribing and
ordering authority to an advanced practice registered nurse who is
qualified for the authority under the rules adopted by the board
under Section 301.152(b)(3). The board may grant full prescribing
and ordering authority to an advanced practice registered nurse who
is qualified for the authority under the rules adopted by the board
under Section 301.152 (c-1) and (c-2).
(b) As authorized by the board, an advanced practice
registered nurse may:
(1) prescribe, procure, administer, and order
dangerous drugs, controlled substances, and medical devices;
(2) diagnose, prescribe, and institute therapy or
referrals of patients to health care agencies, health care
providers, and community resources; and
(3) plan and initiate a therapeutic regimen that
includes ordering and prescribing medical devices and equipment,
nutrition, and diagnostic and supportive services, including home
health care, hospice, physical therapy, and occupational therapy.
(c) An advanced practice registered nurse granted
prescribing and ordering authority under this section shall
practice professional nursing in accordance with standards
established and recognized by the board to protect the public
health and safety.
(d) An advanced practice registered nurse may apply to the
board for prescribing and ordering authority under this section by
submitting to the board an application on the form prescribed by the
board, paying any required fee, and providing any other information
required by the board.
(e) Upon application for prescriptive authority in an
additional role or population focus area by an advanced practice
registered nurse with full prescriptive authority, the board shall
grant full prescriptive authority to the advanced practice
registered nurse who is otherwise qualified.
(f) Nothing in this chapter requires an advanced practice
registered nurse who issues medication orders in a licensed
hospital to obtain provisional or full prescriptive authority if
the advanced practice registered nurse does not issue prescription
drug orders. For purposes of this section, medication orders and
prescription drug orders have the same meaning as in Chapter
551.003, Occupations Code.
SECTION 6. Section 551.003(34), Occupations Code, is
amended to read as follows:
(34) "Practitioner" means:
(A) a person licensed or registered to prescribe,
distribute, administer, or dispense a prescription drug or device
in the course of professional practice in this state, including a
physician, dentist, podiatrist, advanced practice registered
nurse, or veterinarian but excluding a person licensed under this
subtitle;
(B) a person licensed by another state, Canada,
or the United Mexican States in a health field in which, under the
law of this state, a license holder in this state may legally
prescribe a dangerous drug;
(C) a person practicing in another state and
licensed by another state as a physician, dentist, veterinarian,
advanced practice registered nurse, or podiatrist, who has a
current federal Drug Enforcement Administration registration
number and who may legally prescribe a Schedule II, III, IV, or V
controlled substance, as specified under Chapter 481, Health and
Safety Code, in that other state; or
(D) an advanced practice nurse or physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.0511,
157.052, 157.053, 157.054, 157.0541, or 157.0542.
SECTION 7. Section 563.053, Occupations Code, is amended to
read as follows:
Sec. 563.053. DISPENSING OF DANGEROUS DRUGS IN CERTAIN
RURAL AREAS. (a) In this section:
(1) "Advanced practice registered nurse" means an
advanced practice registered nurse granted prescribing and
ordering authority under Section 301.357.
(2) "Reimbursement [, "reimbursement] for cost" means
an additional charge, separate from that imposed for the
physician's or advanced practice registered nurse's professional
services, that includes the cost of the drug product and all other
actual costs to the physician or advanced practice registered nurse
incidental to providing the dispensing service. The term does not
include a separate fee imposed for the act of dispensing the drug
itself.
(b) This section applies to an area located in a county with
a population of 5,000 or less, or in a municipality or an
unincorporated town with a population of less than 2,500, that is
within a 15-mile radius of the physician's or advanced practice
registered nurse's office and in which a pharmacy is not located.
This section does not apply to a municipality or an unincorporated
town that is adjacent to a municipality with a population of 2,500
or more.
(c) A physician who practices medicine or an advanced
practice registered nurse who practices advanced practice nursing
in an area described by Subsection (b) may:
(1) maintain a supply of dangerous drugs in the
physician's or advanced practice registered nurse's office to be
dispensed in the course of treating the physician's or advanced
practice registered nurse's patients; and
(2) be reimbursed for the cost of supplying those
drugs without obtaining a license under Chapter 558.
(d) A physician or advanced practice registered nurse who
dispenses dangerous drugs under Subsection (c) shall:
(1) comply with each labeling provision under this
subtitle applicable to that class of drugs; and
(2) oversee compliance with packaging and
recordkeeping provisions applicable to that class of drugs.
(e) A physician who desires to dispense dangerous drugs
under this section shall notify both the board and the Texas [State
Board of] Medical Board [Examiners] that the physician practices in
an area described by Subsection (b). An advanced practice
registered nurse who desires to dispense dangerous drugs under this
section shall notify both the board and the Texas Board of Nursing
that the advanced practice registered nurse practices in an area
described by Subsection (b). The physician or advanced practice
registered nurse may continue to dispense dangerous drugs in the
area until the board determines, after notice and hearing, that the
physician or advanced practice registered nurse no longer practices
in an area described by Subsection (b).
SECTION 8. Section 481.002(39), Health and Safety Code, is
amended to read as follows:
(39) "Practitioner" means:
(A) a physician, dentist, veterinarian,
podiatrist, scientific investigator, advanced practice registered
nurse, or other person licensed, registered, or otherwise permitted
to distribute, dispense, analyze, conduct research with respect to,
or administer a controlled substance in the course of professional
practice or research in this state;
(B) a pharmacy, hospital, or other institution
licensed, registered, or otherwise permitted to distribute,
dispense, conduct research with respect to, or administer a
controlled substance in the course of professional practice or
research in this state;
(C) a person practicing in and licensed by
another state as a physician, dentist, veterinarian, advanced
practice registered nurse, or podiatrist, having a current Federal
Drug Enforcement Administration registration number, who may
legally prescribe Schedule II, III, IV, or V controlled substances
in that state; or
(D) an advanced practice nurse or physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.0511,
157.052, 157.053, 157.054, 157.0541, or 157.0542, Occupations
Code.
SECTION 9. Section 483.001(12), Health and Safety Code, is
amended to read as follows:
(12) "Practitioner" means a person who is [licensed]:
(A) licensed by the Texas [State Board of]
Medical Board [Examiners], State Board of Dental Examiners, Texas
State Board of Podiatric Medical Examiners, Texas Optometry Board,
or State Board of Veterinary Medical Examiners to prescribe and
administer dangerous drugs;
(B) licensed by another state in a health field
in which, under the laws of this state, a licensee may legally
prescribe dangerous drugs;
(C) licensed in Canada or Mexico in a health
field in which, under the laws of this state, a licensee may legally
prescribe dangerous drugs; [or]
(D) an advanced practice nurse or physician
assistant to whom a physician has delegated the authority to carry
out or sign prescription drug orders under Section 157.0511,
157.052, 157.053, 157.054, 157.0541, or 157.0542, Occupations
Code; or
(E) an advanced practice registered nurse to whom
the Texas Board of Nursing has granted prescribing and ordering
authority under Section 301.357, Occupations Code.
SECTION 10. Not later than January 1, 2012, the Texas Board
of Nursing shall adopt the rules necessary to implement the changes
in law made by this Act.
SECTION 11. The Board shall develop an expedited process to
grant final prescriptive authority to advanced practice nurses who
have prescribed or ordered drugs or medical devices for a minimum of
500 hours under Chapter 157 prior to the effective date of this Act.
SECTION 12. This Act takes effect September 1, 2011.